27Feb

What is a megacolon?

The frequency of diagnosis of bowel disease is second only to diseases of the cardiovascular system. One of the unpleasant and at the same time dangerous pathologies is a megacolon. Timely diagnosis and competent treatment will help to avoid serious consequences.

Contents of

  • 1 What is a megacolon?
  • 2 Types
  • 3 Reasons
  • 4 Clinical picture
  • 5 Diagnosis
  • 6 Treatment
    • 6.1 Conservative
      • 6.1.1 Products recommended for the disease( gallery)
    • 6.2 Surgical
  • 7 Complications
  • 8 Prevention
  • 9 Forecast

What is the megacolon?

large intestine with megacolon

Large intestine with megacolon significantly increases in diameter

Megacolon is a pathological condition of the large intestine, in which it is hypertrophied, as a result of which a single site or organ as a whole increases in diameter. The disease is observed among adults and children, in most cases affects the sigmoid part of the intestine. Pathology can be congenital and acquired.

When the megacolon develops, the patient has various unpleasant symptoms. In addition, a psychotrauma is formed, which should not be left without attention in the treatment of the disease.

Species

Depending on the cause that led to the development of such changes in the intestine, the pathology is divided into the following types:

  1. Hirschsprung's disease, or aganglion. This form is congenital. It is characterized by the absence of nerve plexuses in the rectosigmoidal department, which leads to the cessation of peristalsis in it. During the digestion of food, the lump reaches this site and can not move further. Manifestations of the pathological process begin to occur even in early childhood.
  2. Idiopathic. This type of megacolon is diagnosed in cases when the true cause of the development of the disease was not established.
  3. Endocrine. It occurs against the background of the disorder of endocrine structures: pancreas, thyroid, sexual glands, pituitary gland.
  4. Psychogenic. This type of megacolon, as a rule, is observed in patients with mental disorders.
  5. Neurogenic. It develops in cases of damage to the nerve structures of the large intestine or in pathologies of the brain or spinal cord.
  6. Obstructive. This type of pathological condition occurs when there are mechanical obstructions in the intestines that hamper the progress of feces. These can be fistulas, scars, adhesions, the consequences of inflammatory processes.
  7. Toxic. It is considered one of the most dangerous types of megacolon, as it can lead to death. It develops due to infectious processes in the cavity of the small intestine, can be complicated by sepsis.
Schemes of individual types of megacolon and dolicholithol

Some types of megacolon: a - Favalli-Hirschsprung syndrome;b - idiopathic megacolon;в - дохоколон

Regardless of the form of the megacolon, the disease requires compulsory treatment. Only the specialist can carry out the necessary therapeutic measures.

Reasons for

Various factors may provoke megacolon development, but they differ somewhat depending on the origin of the pathological process. Acquired forms are more likely to arise due to such conditions:

  • influence of medications;
  • intestinal amyloid;
  • traumatic lesions of the walls of the digestive canal;
  • Parkinson's disease;
  • deficiency of thyroid hormones( hypothyroidism);
  • presence of cicatrices, fistulas, collagens in the intestine;
  • infectious bowel disease;
  • oncological processes.

The factors that influence the process of fetal formation during the embryonic growth period can provoke the development of an innate type of disease. It can be:

  • impairment of conduction of nerve impulses;
  • complete or partial absence of nerve endings, responsible for the regulation of the intestine.

In order to properly treat megacolon in an adult or child, it is necessary to begin with the identification of the root cause of the pathological process.

Clinical picture

The degree of severity of the megacolon is determined by the prevalence of the pathological process. It depends on this how much the symptomatology will be expressed. With the congenital form, it begins to manifest itself in the first days after birth or after 2-3 months.

These children are noted:

  • swollen abdomen;
  • flatulence;
  • absence of defecation for 1-2 weeks;
  • vomiting, nausea, signs of dehydration( due to intoxication of the body).

In some cases, after prolonged constipation develops diarrhea. As a rule, devastation of the intestine occurs only after the setting of a siphon enema. When palpation of the anterior wall of the abdomen, it is possible to detect dense strands of accumulated feces.

Megacolon in the child

The megacolon is characterized by an enlarged abdomen and swollen bowel


A characteristic feature of the megacolon is the so-called clay symptom: when you click on the affected area, a pit remains.

However, a congenital megacolon can manifest itself not only among children, but also in adults. In such patients, Hirschsprung's disease for a long time is characterized only by persistent constipation. Only by the age of 20-30 years, additional symptoms of the disease may appear, which help to diagnose and treat.

  1. Patients suffer from chronic constipation, flatulence, pain. And the absence of defecation can not be eliminated by adjusting the diet or using medication. Release the intestine is possible only after staging an enema or gas pipe. Feces have a fetid odor. They contain elements of undigested food, mucus, and blood.
  2. The abdomen becomes swollen, it periodically worries about vomiting, you can find veins of bile among the masses.
  3. Because of permanent constipation, the accumulation of toxic substances in the body, which causes a deterioration in the general condition of the patient. Are noted:
    • dizziness;
    • weight loss;
    • listlessness;
    • drowsiness;
    • apathy;
    • tachycardia;
    • reduced performance;
    • nausea and vomiting.
  4. In the absence of timely treatment, the swollen portion of the large intestine leads to deformation and displacement of the internal organs. This is manifested in the following:
    • disrupts the lungs, heart;
    • the chest becomes barrel-shaped;
    • marked tachycardia, rhythm disturbance, increased respiratory movements;
    • increases the risk of pneumonia, bronchitis due to stagnant phenomena in the lungs.
  5. Develops a violation of metabolic processes, the face, limbs become edematous, there is cyanosis of the skin, anemia.
  6. On the part of the digestive system may occur:
    • dysbacteriosis;
    • perforation;
    • fecal peritonitis;
    • perforation of the mucosa;
    • acute intestinal insufficiency.

This pathology requires compulsory treatment in the early stages, since the advanced stages can lead to serious complications.

Diagnosis

It is possible to determine the presence of a megacolon only after the patient has undergone a complete medical examination. First of all, the doctor collects an anamnesis and conducts a visual examination of the patient, during which he objectively assesses the patient's condition. Be sure to palpate the stomach. This helps to identify soreness, bloating, a symptom of "clay", characteristic of the megacolon.

To confirm the diagnosis, the following research methods are prescribed:

  1. Blood test is general. It allows to determine leukocytosis, as well as the possible development of anemia.
  2. Endoscopic examination of the intestine. It gives an opportunity to see the affected area, to assess its size, the degree of neglect of the pathological process.
  3. Stool analysis. It allows to determine the presence of signs of intestinal dysbacteriosis, as well as the admixture of blood, mucus, undigested food pieces. Also a culture of feces is conducted to determine the possible infection.
  4. X-ray examination. It determines the localization of the swollen part of the intestine, possible deformations or displacement of the internal organs.
  5. Irrigoscopy with contrast agent. Identifies the narrowed and enlarged zones of the intestine, the smoothness of its walls.
  6. Colonoscopy, sigmoidoscopy. Used to inspect the walls of the large intestine.
  7. Biopsy followed by histological examination of the resulting material. It gives an opportunity to see the structure of the walls, to determine the presence of nerve endings in them.
  8. Anorectal manometry. It is used to evaluate the rectal reflex. Using this diagnostic method, the physician can identify the origin of the disease.

As a rule, the megacolon develops slowly enough, so it may take a lot of research to diagnose it, especially if the disease is in its early stages, when the symptomatology is not yet very pronounced.

Treatment of

Before appointing treatment, the doctor must determine the type of megacolon. Removing the manifestations of the pathological process is possible with the help of conservative methods and surgical intervention. Each of them has its clear testimony.

Conservative

Conservative megacolon treatment is complex and involves the use of such methods:

  1. Diet. Correction of nutrition is performed with the aim of softening the stool and facilitating their exit from the intestine. Patients are encouraged to eat foods rich in coarse fiber. You can eat cereal, vegetables, fruits, prunes, sour-milk products.
  2. Medications. For the treatment can be used such groups of drugs:
    • antibiotics: appointed in cases where a megacolon is accompanied by an infectious process or a threat of development of sepsis;
    • bacterial preparations: Bifidumbacterin, Bifikol colibacterin;
    • means for improving intestinal motility: Hexal, Domperidone, Motillium, Motilac;
    • Enzyme preparations: Pancreatin, Creon, Panzinorm, Pangrol.
  3. exercise therapy. Therapeutic physical culture in such a pathology is aimed at strengthening the muscles of the peritoneum.
    Exercise

    With a megacolon, it is necessary to perform exercises aimed at strengthening the abdominal muscles

  4. Massage of the abdomen. This method also gives a good result in complex therapy. It is necessary to make slightly pressing movements clockwise( starting from the area of ​​the stomach).The procedure should be done a quarter of an hour before eating to accelerate the evacuation of stool.
  5. Enemas. Such procedures are used regularly to facilitate the departure of stool. What type of enema is needed in a particular case can only be determined by a doctor taking into account the condition of the patient. Various types are used:
    • vaseline;
    • siphon;
    • cleaning;
    • hypertensive.
  6. Electrostimulation. This procedure involves exposure to the affected area of ​​the large intestine with low-frequency currents, which contribute to increased motility and accelerate the evacuation of stool.
  7. In addition, the doctor can recommend the use of vegetable oil, this will help speed up the process of cleansing the intestine. Adults can drink 30-45 ml three times a day, children will have 15 ml( 1 tablespoon) once a day.

Important! In no case can you use laxatives for the treatment of this disease, as with prolonged use they lead to the development of intestinal obstruction.

Products recommended for the disease( gallery)


Surgical

If conservative methods do not give the desired effect, a surgical method of eliminating the problem is used. Also, the operation is performed with a congenital form of the disease, children are advised to do so at the age of 2-3 years. It consists in the removal of the affected part of the intestine.

In the obstructive form of the megacolon, the immediate cause of the pathological process, i.e., adhesions, scars, narrowed areas, is removed. After excision, both parts of the intestine are sewn together. When there are no contraindications to surgical treatment, during the second operation the sections of the walls are connected.

In some cases, it is not possible to completely cut out a megacolon in one operation. In such situations, a colostomy is established, the feces are collected using a calico. If the second stage of the operation can not be carried out, the patient lives with the intestine withdrawn in the side for the rest of his life.

In the postoperative period, patients are prescribed antibacterial and anti-inflammatory medications, vitamins. Also it is necessary to adhere to the diet, which includes sour-milk products, food with a high content of coarse fiber: fruits, cereals, vegetables. In addition, during rehabilitation the patient undergoes a course of exercise therapy, it is recommended to do an abdominal wall massage in order to strengthen the muscles. For 18 months after carrying out of medical actions patients are on a dispensary account.

Complications of

In the absence of timely treatment, a megacolon can be accompanied by such consequences:

  • fecal peritonitis;
  • dysbiosis;
  • sepsis;
  • intestinal obstruction;
  • perforation of the intestine;
  • internal bleeding;
  • acute intestinal insufficiency;
  • perforation.

Prevention

To prevent the development of a megacolon, you must adhere to simple rules:

Vegetables and fruits

To prevent megacolon, you need to eat more fruits and vegetables.

  1. Proper nutrition. It is worth eating more sour-milk products, vegetables, fruits, cereals, to limit the consumption of food, which contributes to the development of constipation: kissels, fresh pastries, confectionery.
  2. Sufficient level of activity.
  3. Discarding bad habits.
  4. Prophylactic courses of abdominal wall massage. Sufficient muscle tone promotes normal intestinal peristalsis.

Optimum physical activity and proper nutrition are an integral part of prevention, as these factors most often lead to the development of pathology.

Forecast

Life expectancy and quality after treatment depend on the degree of neglect of the pathological process. If the megacolon was diagnosed at an early stage, then adequate and timely therapy helps to eliminate the problem and return the patient to the habitual way of life.

The launched megacolon, as a rule, has a less optimistic forecast. In cases of involvement of a large area, the development of persistent constipation, as well as in the presence of bright symptoms and complications, almost every patient has a lethal outcome.

Megacolon is considered a serious pathology that can cost a patient's life, however, with timely diagnosis and carrying out of necessary medical measures the patient soon completely gets rid of the disease, returning to the usual rhythm of life.